Mitral Valve Repair for Congenital Mitral Valve Disease: Impact of the Use of a Biodegradable Annuloplasty Ring

摘要

Operative TechniqueFollow-UpStatistical AnalysisResultsGeneral OutcomesEarly OutcomeLate OutcomesReoperation and Valve FailureAssessment of Annular GrowthThis study compares the midterm results of mitral valve repair using the biodegradable ring versus repair with non-ring annuloplasty techniques for congenital mitral valve disease in young children where it was not possible to use standard commercial rings.MethodsBetween February 2006 and November 2011, 68 patients underwent mitral valve repair for congenital mitral valve disease. Thirty-nine (57%) patients underwent concomitant annuloplasty using the biodegradable ring (group A) and 29 (43%) patients using non-ring annuloplasty techniques (group B). The median age of repair was 2 years (range 1 month to 14 years).ResultsThere were no hospital deaths or major postoperative morbidity. At a median follow-up of 3.8 years (range, 2 months to 5.1 years), overall survival at 5 years was 97% ± 3% for group A and 88% ± 8% for group B (p?= 0.29). Freedom from valve failure was 90% ± 7% in group A and 74% ± 9% in group B (p?= 0.026). The freedom from reoperation was 100% in group A and 84% ± 9% in group B (p?= 0.04). The mean transmitral gradients were 4.3 ± 1.8 mm Hg in group A and 4.2 ±1.7 mm Hg in group B (p?= 0.77).ConclusionsMitral valve repair using the biodegradable ring for congenital mitral valve disease was superior compared with non-ring annuloplasty repair. Excellent survival benefit, freedom from reoperation, and valve failure without significant elevation of transmitral gradients, suggests its important role in young children with smaller annular sizes where standard commercial rings are not available or recommended.CTSNet classification:35Congenital mitral valve disease encompasses a complex variety of lesions, with various surgical strategies often required to obtain excellent corrective results. Various annuloplasty techniques to stabilize the repair have been described in the literature. Traditionally in the pediatric age group, due to the lack of commercially available annuloplasty rings in smaller patients, one has to resort to the various non-ring annuloplasty techniques. Furthermore, the reason to avoid traditional rings in the pediatric age group were due to the 2 drawbacks related to the ring exposed to foreign material that poses a risk of fibrous tissue overgrowth, which may have an impact on valve function and restricted potential for native annular growth. The concept of a biodegradable annuloplasty ring was described by Chachques and colleagues [